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                         HUMAN RESOURCES IN NURSING

         Managing the Multi-Generational
         Nursing Workforce
         Managerial and Policy Implications
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Managing the Multi-Generational
Nursing Workforce
Managerial and Policy Implications

Developed by Jo Manion
for the International Centre for Human Resources in Nursing

             International Council of Nurses

             Florence Nightingale
             International Foundation
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All rights, including translation into other languages, reserved. No part of this publication may be reproduced
in print, by photostatic means or in any other manner, or stored in a retrieval system, or transmitted in any
form, or sold without the express written permission of the International Centre for Human Resources in
Nursing. Short excerpts (under 300 words) may be reproduced without authorisation, on condition that the
source is indicated.

Copyright © 2009 by ICHRN International Centre for Human Resources in Nursing
3, place Jean-Marteau, 1201 Geneva, Switzerland

ISBN 978-92-95065-50-5
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Table of Contents
About the Author                                                                      7

Foreword                                                                             8

Introduction                                                                         9

Section One: Defining the Generations                                                11

       Managerial Issues Related to the Multi-Generational Workforce                 15

       Managerial Implications                                                       16

               Challenge #1: Creating a workplace culture                            16

               Challenge #2: Remaining adaptive and flexible                         18

               Challenge #3: Dealing with culture clash and conflict                 19

               Challenge #4: Recognizing generational interventions and approaches   20

       Summary                                                                       22

Section Two: Nursing Demographics and the Multi-Generational Workforce               23

Section Three: Managing the Exit of Nurses from the Workforce through Retirement     27

       Factors Influencing Older Nurses’ Employment Decisions                        28

       Strategies for Retaining the Older Nurse                                      31

               Correcting myths and misperceptions of and about older workers        31

               Creation of a high quality, positive work environment                 32

               Changes in the physical environment                                   33

               Alterations in the work                                               34

               Restructured compensation and benefits                                35

               Flexible work schedules                                               36

       Summary                                                                       38

Section Four: Policy Implications                                                    39

Conclusions                                                                          41

References                                                                           42
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About this Paper
This paper is one in a series of documents developed for the International Centre for Human
Resources in Nursing (ICHRN). The series aims to explore nursing human resources issues and
offer policy solutions.

Launched in 2006 by the International Council of Nurses (ICN) and the Florence Nightingale
International Foundation (FNIF), the Centre is dedicated to strengthening the nursing workforce
globally through the development, ongoing monitoring and dissemination of comprehensive
information and tools on nursing human resources policy, management, research and practice.

About the Author
Jo Manion, RN PhD CNAA FAAN, is the founder and principal consultant for Manion & Associates,
an organisational consulting and training company located in Oviedo, Florida, USA. Since the early
1990s she has worked with organisations and individuals engaged in creating effective cultural
change, developing leadership capacity and transforming organisational work environments into
positive, healthy practice workplaces. She is author of Create a Positive Health Care Workplace:
Practical Strategies to Retain Today’s Workforce and Find Tomorrow’s and has written
extensively on issues related to creating a positive practice environment. She is a fellow in the
American Academy of Nursing.

The support and input of a range of stakeholders are gratefully acknowledged.

The International Council of Nurses gratefully acknowledges the financial support provided by the
Burdett Trust for Nursing, United Kingdom.

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The nursing workforce in many countries today is more age diverse than ever before in history.
In developed countries there are as many as four distinct generational age cohorts in active
employment. This age diversity results in a tremendous challenge for the nurse manager as it can
often lead to increased friction and conflict in the workplace. Additionally, each generation has a
distinct set of characteristics, values, beliefs and preferences. Understanding these differences
and blending them in the workplace challenges even the most experienced and capable leader. This
paper identifies the characteristics of each generation and explores several implications for the
effective management of nursing services.

To meet this challenge, four key approaches are explored in depth. The first is based on the belief
that all humans are motivated by several factors held in common. These intrinsic motivators can
be used to guide the development of a positive work environment. The second approach requires
the manager to remain adaptable, flexing the leadership style used for the employees involved.
The third approach centres on managing conflict and friction in the environment and the final
requires an astute understanding on the part of the nurse manager regarding the generational

Clearly, managing the multi-generational workforce is an issue for nurse managers in higher
income countries experiencing an increasing lifespan of the population. It is less clear whether
this phenomenon occurs to the same degree in developing countries where there may be more
homogeneity in the age of the nursing workforce. There are few to no references in the literature
to this as an issue in developing countries. Further, there is limited concrete information available
about the age of the nursing workforce in developing countries. Worldwide, however, there is
clearly both a current and a future nursing workforce shortage with which managers and
organisations must contend.

Commonly used key strategies in approaching nursing shortages are the recruitment of workers
into the field and the retention of those already in nursing. One aspect of retention that is gaining
increased attention is the retention of those nearing retirement age. Retaining the mature or
older nurse is the second major focus of this paper. Six different strategies are identified and
presented. These include: correcting misperceptions about the older worker, creating a positive
work environment, making changes in the physical environment, altering the work, restructuring
compensation and benefit packages, and offering flexible work schedules.

While there are many individual, organisational and national strategies that focus on managing
the multi-generational workforce and retaining the older worker, there are also strategies necessary
at the policy level as these two factors seriously challenge the ability to maintain an adequate and
effective nursing workforce. A variety of policy implications are presented in the final section of
this paper.

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A healthy, vibrant nursing workforce is a primary ingredient for the provision of health care and
a universal concern in today’s world. In many countries and health systems the nursing workforce
is more age diverse than ever before in history. For the first time, there are as many as four
generations of nurses working together. This diversity can be overwhelming for managers trying
to understand the implications for their practice. Much has been written concerning the different
experiences and values of members of the different generations, as well as their needs and
behaviours in the workplace. However, the practical implications of managing and balancing the
impact of these differences are less clear. Although there are any number of authors suggesting
implications for managerial approaches, there is little research that actually tests these suggestions
and recommendations.

A primary role of the nurse manager is the creation of a healthy, productive, positive practice
environment. For this reason, nurse managers need the skills to deal with the diversity represented
by a multi-generational workforce. While diversity in the workplace can lead to increased creativity
and a greater richness of values and skills, it can also lead to value clashes, disrespect of each
other’s viewpoints, and increased conflict (Swearingen & Liberman 2004; Kupperschmidt 2006).
Today’s health care organisation, struggling with matching resources to needs, cannot afford the
high cost of generational enmity.

This issue is increasingly significant in light of current and future nursing workforce shortages.
Three primary strategies are used during nursing shortages (Hatcher et al. 2006). The first
involves the recruitment of increasing numbers of students into nursing education programmes.
Although this continues to be an important strategy, it is clearly not going to produce enough
nurses to meet the demands. Although there are many operant factors, as population demographics
change, there is an increasingly smaller pool of potential applicants from which to draw.
Compounding the difficulty with this strategy are the shortages of experienced, qualified faculty
and limited availability of physical sites for student clinical education.

A second strategy in many countries for dealing with a nursing shortage is encouraging the
migration of nurses from other countries. Although there are benefits to this approach, it does not
help the overall global shortage of nursing workforce. “Those potentially advantaged often include
the individuals who move and the source, or home, country that receives capital in the form of
remittances from those who have moved. At the same time, major disadvantages are incurred if
departures impair a country’s ability to deliver vital services in local communities” (Pittman, Aiken
& Buchan 2007 p1275). Additionally, many developing countries publicly fund nurse education,
making the departure of nurses to wealthier countries an even greater loss.

The third key strategy for resolving a nursing shortage is the retention of practicing nurses. This
strategy is the primary focus of this paper. There is a two-pronged approach in this strategy. The
first is to understand what makes a healthy practice environment and an employment setting where
nurses want to work. The underlying assumption is that if these elements are in place, nurses choose
to remain and retention is positively impacted. A second approach is the implementation of actions
that specifically target older nurses approaching retirement age in order to prolong their working
career and years of contribution. This paper focuses on both of these approaches — effectively
managing a multi-generational workforce in a way that enhances the quality of the workplace and
retains professional nurses, especially those nearing retirement, in the practice setting.

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Section One examines the definition of the generations and identifies common characteristics and
beliefs attributed to each of the four generations. Managerial issues and implications for managing
nursing services are also examined. Section Two presents available data describing the varying
age profiles of nurses in different systems and countries. The third section presents findings from
the literature regarding strategies for retaining the older nurse in the workplace. The final section
presents policy implications based on a review of the literature.

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Section One:
Defining the Generations
Generational groups are often referred to as cohorts, whose members are linked to each other
through shared life experiences during their formative years. As each cohort ages, it is influenced
by what sociologists call generational markers. As products of their environment, members of the
cohort are influenced by events that have an impact on all members of the generational grouping
(Zemke et al. 2000). They share birth years, history, and develop a collective personality as a result
of these generational events. It is believed that each generation possesses unique characteristics
and cultural differences from that of preceding and subsequent generations. An acute awareness
of these differences began surfacing in the early 1990s as it became apparent there were distinct
differences between workers of the different generations.

Although the mean age of the global population is declining, with 50 percent of the world’s current
population younger than 20 years of age, this is not the case in developed countries (Alexander
2006). Upcoming population shifts in developed countries result in increased concern with the
needs and desires of middle-aged and older citizens (Dychtwald 1990). A combined senior boom
and a declining birth rate in many developed countries has resulted in an increase in population of
persons over 65 years of age. In the higher income countries, the ratio of active workers to retired
persons is declining.

After the Second World War, births rose dramatically in many parts of the world. In some countries
this birth spurt lasted only a few years. However, in the United States of America (USA), Canada,
Australia and New Zealand the so-called baby boom lasted for nearly two decades. “Baby Boomers”
are individuals born between the years of 1946 and 1964. This large population cohort has
dramatically increased awareness of generational differences, both from their experiences as they
entered into the workforce (which were different from their parents) and again, as the succeeding
generation entered the workforce and demonstrated markedly different attitudes and belief
systems. Other factors have also precipitated our awareness of generational differences. For
example, in Italy, the age for retirement was previously set by law to be 39 years. When this was
increased, the number of older nurses wanting to remain employed also increased (Palese et al.
2006), and thus, generational differences became increasingly apparent.

The four defined generations in today’s nursing workforce include:
• Veterans (those born between 1922 and 1945)
• Baby Boomers (those born between 1946 and 1964)
• Generation X (those born between 1965 and 1979)
• Millennials or Generation Y (those born between 1980 and 2000)

The years encompassing these generations varies somewhat by author, based on their experiences
with how the members of the cohorts think and act. There are no hard stops that indicate when
one generation ends and another begins. These time frames are only guidelines. People born
during these years share a common history as a result of the events that occurred during their
formative years as well as the conditions of the workplace when they entered.

There is a danger in stereotyping or labelling that can occur when characteristics of a particular
group are identified and presented as absolute fact. It certainly does not mean that these
characteristics or attributes are shared by every individual born between these years. Although

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generational differences do account for diversity in the workplace, so can many other factors,
such as cultural heritage, personality traits, and individualised experiences. However, understanding
generational information can help explain the sometimes baffling and confusing differences in
our unspoken assumptions about how the world operates. It can serve as a beginning point in
understanding what people believe and hold important. Insight into the values of the different
generations helps us see how these values influence organisational values and the interface
between work and family. The following is a summary of the most common differentiating factors
of the various generations reported in the literature. More thorough descriptions of these
generational cohorts are offered by Duchscher and Cowin (2004).

The Veterans (1922-1945) “The Loyal Generation”
The Veterans grew up in hard times, including the Great Depression in the USA and the Second
World War. They rose to the challenge of rebuilding nations and economies, and creating a new
foundation for generations to come. Most came of age during the transition from a primarily
agricultural way of life to a manufacturing mind-set (Zemke et al. 2000). Living through economic
and political uncertainty resulted in their being hard working, financially conservative, and
cautious (Sherman 2005).

Veterans like consistency, uniformity, and things on a grand scale. They tend to be conformers
and value organisational loyalty. Longevity and tenure is, for them, an appropriate basis for
progression and promotion in their career. They believe in propriety and logic and are disciplined.
Members of this generation value the lessons of history and tend to look back and reflect on
precedents set that might be helpful and applicable in the present. Their most enduring workplace
legacy is the hierarchy and the old command and control management style (Zemke et al. 2000).
They do not take their job for granted and are used to working hard to get things accomplished.

The Baby Boomers (1946-1964) “The Loved Generation”
The Baby Boomers grew up in optimistic, positive times. In many developed countries, this was a
time of expansion. Most were raised in child-centred nuclear families and grew into egocentric
adults who have continued to rewrite the rules, rather than follow the traditional path (Zemke
et al. 2000). Boomers learned about collaboration and teamwork as they were growing up and
brought it into the workplace. They pursued their own personal gratification relentlessly
without regard to the cost on relationships and others. Baby Boomers are still optimistic and
believe in the infinite possibilities in the world today.

As the Baby Boomers turn 50, work is slowly slipping down on their list of priorities. As a result, the
workplace is becoming more informal and more humane (Zemke et al. 2000). The Baby Boomers
have redefined and popularized every phase of life as they have passed through it. They form the
largest cohort of nurses and the oldest segment of this group is within a few years of reaching
retirement age. One survey found that “more than two-thirds plan to work after retiring. Most plan
to work part time, and a few will even pursue a new career full time” (Zemke et al. 2000 p89).

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Generation X (1965-1979) “The Lost Generation”
This unique generation is a group that went basically unnoticed until the late 1990s. As a generation
it is defined more by what it is not, than what it is. Maligned and misunderstood, much of what has
been written about this generation is through the eyes of Baby Boomers who simply see them in
contrast to themselves rather than as a unique generation. They are often described as “Baby
Boomers’ children who inherited Boomers’ social debris: divorce and dual-career parents resulting
in Latch Key Kid experiences” (Kupperschmidt 2006 p3). They grew up independent and self-reliant.
They saw their parents sacrifice time with them to further their careers, only to be later downsized
or restructured out of their positions.

Zemke, Raines and Filipsczak (2000) believe that a person’s first job experience significantly impacts
their values and expectations of the workplace. For example, in the USA many Generation Xers’
initial work experiences occurred during a time of national recession and massive reorganisation
and restructuring efforts in health care. The lesson learned is that there is no such thing as job
security, hierarchical reverence is worthless, and paying your dues is just a worn-out cliché from
the previous generation. Instead, increasing your own marketability through additional job skills
and development is the path to success. One way to accomplish this is by changing jobs frequently.
Santos and Cox (2000) reported that the Generation Xers in their study clearly indicated they
anticipated moving out of their organisation and even the profession during the course of their
work life. “They indicated this arrogance was not arrogance at all but the need to be self-reliant
as they have had to be throughout their lifetime” (p12).

The Generation X cohort is smaller than the Baby Boomers. Add the fact that fewer Generation
Xers chose nursing as a career in the 1990s, and there is a demographic collision waiting to
happen as the Baby Boomers today are beginning to transition from the active workforce. The
good news is that more Generation Xers are choosing nursing as a second or even third career
(Kupperschmidt 2006; Sherman 2006).

The Millennials or Generation Y (1980-2000) “The Linked Generation”
The Millennials are the second largest cohort in the general population (Raines 2002). Raised by
nurturing parents, they have lived structured and incredibly busy lives filled with activities and scheduled
events that rival the most workaholic Baby Boomer. They value their families highly and remain close
within them. During their childhood they saw violence, terrorism and drugs become realities of life.
They are the first truly global generation and have incorporated multiculturism as a way of life. They
are the most connected generation in history. Advanced computer technology and instant, constant
communication through cellular phones and text messaging are a way of life for these people.

In a qualitative study conducted of Italian chief nurses, the authors report that “‘Fragility’ is a
characteristic found in all of those belonging to Generation Y, having grown up in a family environment
in an overprotective society which tended not to give them responsibility” (Palese et al. 2006
p179). This is also the generation that grew up with the mentality of “everybody gets a blue ribbon”
and everyone gets selected for the team. Some managers are finding that in working with members
of this generation, they also must contend with the employee’s parents who are so overly
involved in their child’s life that they become part of the workplace relationship as well,
communicating with the manager about issues, giving approval for schedules, and even attending
performance appraisals!

Conventional wisdom suggests there are differences in characteristics of generational cohorts.
Although little research has been done to substantiate this claim, there are many authors who
offer observations on the core values of each generational cohort as well as project their assets
and liabilities on the job. Table 1 offers a brief overview of the differences between the generations
for purposes of understanding the challenges faced by nurse managers.

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Table 1: Generational Differences

                    Veterans                  Baby Boomers               Gen Xers               Millennials

Core Values         • Dedication/sacrifice    • Optimism                 • Diversity            • Optimism
                    • Hard work               • Team orientation         • Thinking globally    • Civic duty
                    • Conformity              • Personal gratification   • Balance private      • Confidence
                    • Law & order             • Health & wellness          & work life          • Achievement
                    • Respect for authority   • Personal growth          • Technoliteracy       • Sociability
                    • Patience                • Work                     • Fun                  • Morality
                    • Delayed reward          • Youth                    • Informality          • Street smarts
                    • Duty before pleasure    • Involvement              • Self-reliance        • Diversity
                    • Follow the rules        • Like to belong           • Pragmatism           • Idealistic
                    • Honour                                             • Apolitical           • Prefer no ties
                                                                         • Prefer no ties
                                                                         • Start at the top

Assets on the Job   • Stable                  • Service oriented         • Adaptable            • Collective action
                    • Detail oriented         • Driven                   • Technoliterate       • Optimism
                    • Thorough                • Willing to go the        • Independent          • Tenacity
                    • Loyal                     extra mile               • Unintimidated by     • Heroic spirit
                    • Hard working            • Good at                    authority            • Multitasking
                                                relationships            • Creative               capabilities
                                              • Want to please           • Focused on career    • Technological
                                              • Good team players        • Want variety            savvy
                                              • Focused on the job                              • Ambitious

Liabilities on      • Inept with ambiguity    • Not naturally            • Impatient            • Need for supervision
the Job               and change                budget minded            • Poor people skills     & structure
                    • Reluctant to buck       • Uncomfortable            • Inexperienced        • Inexperience,
                      the system                with conflict            • Cynical, sceptical     especially handling
                    • Uncomfortable           • Reluctant to go          • Will not sacrifice     difficult people
                      with conflict             against peers              for the job            issues
                    • Reticent when           • Overly sensitive         • Lack of respect
                      they disagree             to feedback                for authority
                                              • Judgmental of
                                                those who see
                                                things differently
                                              • Self-centred
                                              • Sacrifice for the job
                                              • Little faith in

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Managerial Issues Related to the
Multi-Generational Workforce
The incredible amount of diversity in today’s workplace places demands on current nurse managers
unlike any previously experienced. Diversity is not limited to generational differences although
those are the subject of this paper. The presence of diversity in other areas simply increases the
importance of managerial skills for effectively dealing with diversity. The current generational
diversity in developed countries is also unique in a rather striking way. The generations in today’s
workforce are more likely to be mixed at all levels of the organisation. In the past, older workers
were often at the more senior levels of management with younger workers on the front-line.
However, generational status is no longer tightly linked to job status. Whereas in the past the
question from Baby Boomer managers was “How do I manage these young Generation Xers?”, the
question today is just as often from the Generation X manager who asks “How do I manage these
Baby Boomers?” Members of all generations can be found at all levels in the organisation.

This is not as likely to be true in the developing countries. In many countries of the world, positions
in the hierarchy are held by older workers. In some instances, this can actually create a bottleneck
for career progression of younger nurses who must wait until the senior nurses retire before new
possibilities for promotion are made available.

The uniqueness of this situation is seen in another way as well. As the age of new nursing graduates
continues to rise, generation-specific understanding becomes important for nursing faculty
and schools of nursing. In most Western countries, the new nursing graduate is no longer most
frequently a 21 or 22 year old young woman.

The challenges and implications of managing a multi-generational workforce include the following:

Challenge #1
Creating a workplace culture that engages all workers and results in a high retention rate

Challenge #2
Remaining adaptive to current circumstances and responding with flexibility in approaches
and practices

Challenge #3
Effectively dealing with the culture clash and conflict that can occur between generations

Challenge #4
Recognizing and using generational-specific interventions and approaches

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Managerial Implications
Challenge #1
Creating a workplace culture that engages all workers
and results in a high retention rate
The highly effective nurse manager is one who recognizes the importance of creating a workplace that
supports a positive, healthy practice environment (Stuenkel & Cohen 2005; Manion 2005). While it is
clear there are potential differences between members of the various generational cohorts, focusing
solely on the differences can create a sense of hopelessness or unfounded pessimism. It is helpful to
remember that while members of each generation may be different in many ways, they are also alike
in many ways. And, ultimately, focusing on the universality of our human experience may serve as a
beginning point for the nurse manager interested in retaining nurses. In fact, some research suggests
that the differences in the values of the four generations in the nursing workforce are not as divergent
as sometimes reported. McNeese-Smith and Crook report that “Generation X had higher values for both
variety and economic returns. However, no other significant differences were identified” (2003 p266).

In examining the psychological, sociological and organisational development research on human
motivators, five basic intrinsic human motivators emerge (Thomas 2002; Manion 2005). When the
manager understands these primary motivators, they can serve as a guide for creating a positive
practice environment.

The intrinsic motivators are:
1. The presence of healthy interpersonal relationships
2. Having meaningful work
3. Experiencing a sense of competence or self-efficacy
4. Having autonomy or choice
5. The achievement of progress

Healthy Interpersonal Relationships
When people enjoy healthy positive relationships with others in the workplace it leads to stronger
commitment to the organisation and impacts the quality of care provided. Co-worker friendliness
and cooperation are important reasons health care workers stay with their jobs (Strachota et al.
2003; Kangas et al. 1999). It has become conventional wisdom that the relationship between
employee and manager is one of the most crucial in determining the employee’s commitment to
stay with the organisation.

Healthy relationships are defined as those characterized by high levels of trust, mutual respect,
unconditional mutual support, and communication that is open, honest, direct, and primarily
positive (Manion 2005).

Meaningful Work
When a person sees their work as meaningful and important, they are more likely to be motivated
to continue it even if it requires sacrifice or challenge. “People have a desire to be engaged in
meaningful work— to be doing something they experience as worthwhile and fulfilling” (Thomas
2000 p12). If work is composed of tasks and responsibilities that serve a particular end or accomplish
a specific purpose that is meaningful to an individual, it brings about the desire to continue.

People want to feel like they are performing their work activities well, that their performance meets
or exceeds established external as well as internal standards. In fact, recent findings from the field of
positive psychology indicate that people are more likely to be happy at work if they use their talents

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and strengths on a consistent basis (Seligman 2002). A sense of self-efficacy often leads to strong
feelings of pride, a positive emotion that accompanies personal accomplishment.

Choice occurs when individuals have appropriate levels of autonomy and control in their work. They
participate actively and are involved in making decisions that impact their work and its outcomes.
Because choice is part of the environment, people feel that their views, ideas, and insights are
important. Choice also involves a sense of ownership experienced when people feel personally
responsible for outcomes of their decisions and behaviours.

A strong intrinsic motivator is experiencing a sense of progress; people’s belief that their actions
and behaviours had their intended impact. Little is more discouraging than feeling that nothing
has changed as a result of effort and hard work. A sense of progress builds momentum and
enthusiasm, resulting in the energy of commitment.

Managerial Interventions
Knowledge of these five intrinsic motivators can be used by the wise manager to create a positive
workplace. Examples of managerial interventions include:

Healthy Relationships
• Clearly define what is meant by healthy relationships
• Clarify the employee’s responsibility for creating and maintaining healthy relationships with others
• Teach the skills of conflict resolution, giving feedback, active listening, and other communication skills
• Lead the establishment of healthy working relationships with members of other disciplines and
  departments, between shifts and co-workers

Meaningful Work
• Remind employees of the meaningfulness of their work and how they are contributing
• Reduce non-value added work such as duplicative efforts, busy work, work with no clear value
• Share stories of how employees have impacted patients and others through their meaningful

• Coach employees in the development of their skills
• Engage in conversation with individual nurses to determine their interests and desires for
  learning new skills or competencies
• Provide opportunities for employees to grow and continue to develop

• Ask for input, involve employees in making decisions that impact their work
• Create models of shared decision-making such as shared governance structures
• Do not expect everyone to do things the same way, when possible allow for individual choice
  in how work is carried out

• Recognize incremental progress as it occurs, instead of waiting for the final goal to be achieved
• Celebrate accomplishments and achievements
• Track progress and remind people of the progress made

These basics can serve as a starting point for creating a positive work environment and there is
ample support in the literature for beginning here. When analyzing any of the documents that
identify organisational characteristics of excellence (such as Magnet Hospitals), the elements
identified can almost always be linked back to one of these five intrinsic motivators.

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However, a few cautions and clarifications about using these intrinsic motivators is in order. First,
not all of the intrinsic motivators are equally important to everyone. Members of generational
cohorts may vary in at least three distinct ways. First, what is most important to them as a cohort
may be different. For example, Baby Boomers are said to value relationships and attach a great
deal of importance to the meaningfulness of their work. Generation Xers, as a broad age cohort,
clearly value their competence and self-efficacy as well as having jobs that stress independence,
autonomy, and choice. Again, however, this does not mean that there cannot be overlap in
individuals in these various generational cohorts.

Another way the members of the different generations may be different is in how they define the
meaningfulness of their work. The Millennials have a strong sense of civic duty and are likely to
define meaningful work as work that contributes to societal good while a Generation Xer may
define meaningful work as work that advances their career or helps them develop a broader range
of skills in order to become personally more marketable. Members of the Veterans generation may
define meaningful work as that which provides safety and security for their family and community.

And yet a third way the generations may be different is in what they are likely to do if the workplace
does not provide for their most important values or needs. For example, Baby Boomers may be
more inclined to stay with an organisation because they value security and longevity. Generation
Xers are more likely to leave and go onto another job. One Generation X manager demonstrated
this when she told her colleagues: “When I stop learning anything new in this job, I’m out of here.”
This relates to the universal human motivator of competence but also illustrates a generational
difference in how she will handle her disappointment when her job fails to provide what is
important to her.

Challenge #2
Remaining adaptive to current circumstances and
responding with flexibility in approaches and practices
It has long been recognized and accepted that a hallmark of managerial effectiveness is the ability
of the manager to assess what is needed in a given situation or interaction, and respond flexibly,
choosing a response that matches the situation. In the 1960s the model of situational leadership
was developed and is still of practical value in today’s work world. To be effective, the leader
accurately diagnoses the situation and uses an appropriate style to supplement what the follower
lacks. This requires flexibility on the part of the leader. In the same way, the high level of diversity
in the workplace means that an effective leader must adapt their style and approach to meet the
needs of the follower. Managers who put their staff first are more likely to find that the staff puts
the patient first (Manion 2005). Flexibility and versatility require keen judgment on the part of the
manager and the ability to move between various styles and approaches.

This challenge is daunting, to say the least. It is based on understanding that one approach does
not fit every person or every situation. One key principle can make it easier. Instead of assuming
all employees fit the defined characteristics of a particular generational cohort, ask employees
directly what is important to them or how they want to be treated. Nothing can substitute for
knowing employees well and matching the workplace culture with what they believe is important.

One potential difference between the members of the various generations is in what they expect
from their nurse manager. Wieck, Prydun and Walsh (2003) studied members of the “entrenched
generations” and the “emerging generations” to determine what they want from their nursing

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leaders. Interestingly, out of 56 characteristics, seven appeared on the characteristics list of both
groups. There were no statistical differences found in how the characteristics were ranked
between the older and younger generations. Honesty was high on the list for both groups. Eight
of the 10 characteristics identified by the younger nurses could be categorized as “nurturing”.
“These traits—motivational, receptive, positive, good communicator, team player, good people
skills, approachable and supportive—all depict an environment in which younger nurses feel
nurtured and supported” (p287). In further research, as yet unpublished, Wieck reports that the
generations seem to have similar desires for their managers. The characteristics depict a flexible,
nurturing manager.

Challenge #3
Effectively dealing with the culture clash and conflict
that can occur between generations
Conflicts occur more readily when people hold different values, especially in the high-stress
environments that characterize health care organisations. Many authors report a particularly
negative subculture within nursing that includes high levels of horizontal violence and dysfunctional
interpersonal behaviours (Santos & Cox 2000; Swearingen & Liberman 2004; Kupperschmidt
2006; WHO 2006). This type of negative culture can lead to toxic behaviours such as discounting
each other, making rude or cruel comments about people who are different, withholding important
information, and other forms of disrespect. It is Kupperschmidt’s (2006) contention that mutual
respect is a key factor in reducing intergenerational conflict in the workplace. An effective manager
is aware of what is going on in the work area and addresses negative behaviours immediately.

Examples of important managerial interventions for dealing with conflict include:
• Establish clear expectations for behaviours based on the elements of healthy relationships

• Lead the work group in establishing their behavioural expectations of each other, developing
  a code of conduct or an operating agreement that clearly spells out which behaviours are
  desirable and which are not acceptable

• Set a no tolerance policy for gossip, behaviour that demeans others, toxic aggression, chronic
  negativity, bullying, mean-spiritedness, or disrespect

• Ensure that employees have skills in healthy conflict resolution and giving each other feedback,
  both positive and constructive

• Engage the staff in value clarification exercises that focus on the different values each holds

• Continually reemphasize the common mission or purpose that binds people together

In a qualitative study of chief nurses (charge nurses) in Italy, researchers reported that there did
not seem to be any real conflict between the generational groups. Instead, they found that the
coexistence of a number of different generations in the workplace led to the formation of small
groups of individuals who are similar in attitude and behaviour, but at odds with groups made up
of staff from different generations. They report that these small groups did not seem to compete
between themselves, but instead had different objectives. And when employees separated into
generational groups, “the staff lose the opportunity of a reciprocal exchange of information which
would benefit both the staff and the patients” (Palese et al. 2006 p181).

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Challenge #4
Recognizing and using generational-specific interventions
and approaches
The final challenge facing the nurse manager is to become knowledgeable about generational
differences and skilled in using generational-specific interventions and approaches. Although it is
dangerous to assume that the characteristics discussed in the earlier section apply equally to all
individuals within a cohort, it can be just as dangerous to assume everyone is alike and needs to
be treated exactly the same. An understanding of generational differences can be a beginning
point in making sense of behaviours and beliefs. Many authors (Kupperschmidt 2006; Lancaster
& Stillman 2002; Sherman 2006; Wieck 2000, 2003, 2006; Zemke 2002) offer specific guidelines
for ways to approach recruiting, orienting, training, motivating, and coaching individuals from
different generations. These are summarized in Table 2. Although these may be helpful, it is
important to remember that no research testing these managerial interventions was revealed
through the literature review.

Table 2: Managerial Ramifications of Generational Differences

                    Veterans                  Baby Boomers              Gen Xers                   Millennials
Recruiting          • Consider them           • Acknowledge             • Emphasize balance        • Sell organisation
                    • Like part-time work       experience              • Stress merit               solidly
                      & projects              • Set a challenge         • Discuss changes          • Show opportunity
                    • Stress their valuable   • Stress a humane           expected                 • Emphasize
                      experience                environment             • Create a fun, intimate     organisation’s
                    • Be courteous and        • Give them credit          environment                importance
                      respectful (please,       and respect for their   • Emphasize                • Sell them on the job
                      thank you, etc.)          achievements              technology               • Tell how organisation
                    • Messages that           • Show them how           • Emphasize                  meets its civic duties
                      speak to traditional      they can be a star        independence             • Customize job
                      values work                                       • Flexibility in             opportunities
                                                                          scheduling               • Flexibility

Orienting           • Take the time           • Emphasize goals         • Show technology,         • Be clear on
                      to explain                & challenges              allow for exploring        expectations
                    • Share the               • Show them the           • Show “who’s who”         • Show opportunities
                      organisation’s            opportunity               list, who knows what     • Emphasize equality
                      story                                             • Repeat the work/life     • Sheltered, will need
                    • Bring them into                                     balance message            lots of support
                      the goals of the                                  • De-emphasize the
                      group, how they                                     politics
                      will contribute

Training            • Need technology         • Share strategy,         • Give multiple            • Provide how-to
                      training, but don’t       budgeting, etc.           opportunities              training
                      underestimate           • Use their book          • Stress self-             • Assign mentors
                    • Take time, use an         knowledge                 development              • Use lots of details
                      older trainer           • Give developmental      • They’re more self-       • Like collaborative
                    • Use large text in         assignments               directed learners          action, group work
                      printed materials       • Use books, tapes,       • More task, not             & high involvement
                                                & videos                  process-oriented         • Use interactive
                                                                        • Dislike groups and         approach
                                                                          meetings                 • Didactic lectures
                                                                        • Be brief                   are boring to them
                                                                        • Stress project

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Table 2 continued
                    Veterans                 Baby Boomers               Gen Xers                 Millennials

Motivating          • Use the personal       • Personal relationships   • Opportunities to       • Competitive pay
                      touch, notes & calls     are important              develop skills           & benefits
                    • Traditional perks      • Public recognition       • Opportunities for      • Good environment
                    • Use them as mentors    • Work perks                 promotion              • Show opportunities
                    • Reward is a job        • Name recognition         • Multiple tasks and       for advancement
                      well done                (get them quoted)          projects               • Career planning
                                             • Reward hours and         • Give feedback but do     & counselling
                                               efforts                    NOT micromanage        • Socially conscious
                                             • Talk about legacy        • Allow laxness          • Feeling like I do my
                                             • Like involvement         • Freedom is a reward      job well
                                               & participation                                   • Reward is
                                                                                                   meaningful work

Coaching            • Tactful                • Tactful                  • Be direct & honest     • Like public
                    • Private                • Create harmony,          • Value equity             recognition
                    • Build rapport            warmth, agreement          & fairness             • Develop trust
                    • Be respectful          • Use questions, not       • More relaxed           • Be honest & direct
                    • Ask permission           statements                 & informal             • Listen
                      to coach               • Treat as equals          • Feedback needs to      • Show confidence
                    • “No news is            • Ask questions to           be continual and       • Treat like an adult
                      good news”               get to the issues          focused on “How        • They expect
                                             • Yearly feedback with       am I doing?”             feedback with the
                                               documentation                                       push of a button
                                                                                                 • Need detail &

While all employees must be held to the same work expectations and organisational policies and
procedures (Hart 2006), managerial approaches can take generational differences into account.
For example, according to Lancaster and Stillman (2002) the way members of the different
generations perceive authority can be somewhat disconcerting unless understood. Veterans tend
to believe in and follow the chain of command while Baby Boomers expect a change of command.
They want to rewrite the rules. Generation Xers believe in self command and Millennials collaborate
rather than believe in command.

Rewards are important to individualise as well. Veterans value a job well done while Baby Boomers
like titles and recognition. Generation Xers want the reward of freedom to do things their own way
and for Millennials it is a sense of meaningfulness of the work. Hart (2006) reports that Baby
Boomers are influenced by money and the younger generations by time off. Finding ways to meet
the needs of the different generations is the challenge for today’s organisations.

How they view job changes can also explain the difficulty in retaining younger generations. While
Veterans see changing jobs as a stigma the Baby Boomers find that changing jobs puts them
behind. Generation Xers see it as a necessity while Millennials consider a job change almost as a
daily routine. Baby Boomers are focused on the job while members of the younger generation are
focused on a career. Palese et al. (2006) found that a sense of belonging was important to older
nurses while younger nurses wanted few ties in the workplace so they would be free to be nomadic.

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It is widely believed and accepted that the values, ambitions, views, beliefs and behaviours vary
according to generational cohorts. Reports of these differences come from developed nations,
and the extent to which this is true in developing countries remains to be seen. Swearingen and
Liberman (2004, p55) believe that “similarities of experience within and differentiation of
experiences between age group cohorts are observable in every culture. Similar functioning is
imposed by society on those sharing an age cohort at a particular time. The same is true of any
major event in personal history, which is identified by age.” However, a cautionary note must be
interjected here. Although it may be apparent that there are differences between generations,
the actual characteristics and attributes reported here may have only limited applicability in
developing countries. No literature was found reporting these kinds of differences in developing
countries. They may exist, but the phenomenon may not be as widespread as it relates to the
nursing workforce in these countries. Clearly, in countries with a shorter life expectancy, there
may be more homogeneity reflected in the generations active in the workforce.

A second cautionary note must be added. Much has been made of the differences between
members of the various cohorts. However, the truth is that there are many factors that influence
what is important to people in their work. Generational differences certainly account for and
explain part of the situation. The members of different generations have had different lived
experiences and these influence the way they view their work and their behaviours in relation to
their careers. However, it is likely that there are other significant factors that are less frequently
discussed. One striking factor is simply that people need and value different things at different
ages throughout their lives. It makes sense that younger workers entering their field are likely
to be focused on gaining mastery and building their levels of competence. When these younger
workers begin raising a family, their needs and desires about workplace benefits, working
schedules, and opportunities are affected by this major life change they are experiencing.
Workers nearing the end of their career are more interested in their legacy and planning for
transition to a reduced work life or retirement. Social issues also affect what is important to
people in the various generations and in different countries. For example, the frequency of
grandparents raising grandchildren is increasing.

And a final reminder: No matter how well researched the characteristics of the various generations
are, pronouncements of certain values or attributes never apply consistently to all members of the
age cohort. Individual personalities and experiences can account for many variations as well. And
although some of these generalisations may be helpful, ultimately they must be validated with the
individual or work group to determine their applicability.

As mentioned earlier, when members of different generations focus on and emphasize how they
are different from one another, it can raise barriers and lead to increased conflict between people.
An alternative strategy is to recognize the possibility of differences, yet understand that there are
many universal elements of the human experience. When a manager recognizes and builds on
similarities, it may ultimately be more useful in bringing people together. Thus a key managerial
strategy is to build on how nurses are alike while respecting how nurses are different.

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Section Two:
Nursing Demographics and the
Multi-Generational Workforce
Data related to the ageing and changing demographics of the nursing workforce is incomplete at
best and the picture is paradoxical. While developed countries are experiencing an ageing of the
population, this is not true in many developing countries. Life expectancy in sub-Saharan Africa,
for example, is dropping dramatically (Spinks & Moore 2007). Reported in Alexander (2006 p606),
Kotlikoff and Burns say: “The mean age of the global population is declining, with 50 percent of
the world’s current population younger than 20 years of age. Conversely, industrialized nations are
‘going gray’ with a rising median age and a declining ratio of active workers to retired persons.”

Not all countries report or have accurate data on their nursing workforce. Pittman, Aiken and
Buchan (2007) have studied extensively the issue of international migration of nurses and have
found that monitoring the data is problematic. They note that, with the exception of the
Philippines, most of the data available on migration of nurses from source countries is derived
from the destination countries. “The lack of data in many developing nations, the problems of
inconsistencies of definitions of nurses, and of comparability of data sources are apparent”
(p1279). Although there are relatively extensive reports of data supporting the conclusion that
severe nursing shortages exist around the world, in analyzing this data, the demographic of the
nurses’ age is addressed infrequently and what is available comes from developed countries.

The USA has the largest professional nurse workforce of any country in the world, almost 20 percent
of the world’s supply and about half of all English-speaking nurses (Aiken 2007 p1299). With a
nursing workforce of this size, even small changes in supply-demand imbalances can create a serious
ripple effect, both in the USA as well as internationally. Hart (2007) reports on American nursing
demographic changes in Nursing Economics. The Bureau of Labor Statistics released nursing
workforce projections for 2004-2014 which included an increase in the 55-64 age cohort of more
than seven million. The number of workers 65 and older is expected to increase nearly seven times
as fast as the total labour force. She suggests that workers postponing retirement account for this
upswing in the older categories. The most recent national RN survey conducted by the Health
Resources and Services Administration estimates the average age of the registered nurse as 46.8
which is more than a year older than the estimated average of 45.2 from the 2000 survey.

The average age of nurses is higher in the developed countries and it is comparable between
them. “The average age of a nurse is in the low to mid forties in many developed countries”
(Buchan & Calman 2005 p22). A statistic of concern reported by Buerhaus (2002 p4): “Between
1983 and 1998, the number of RNs in the workforce younger than 30 years fell 41%.” In 2002
more than 60 percent of the US nursing workforce was older than 40 years.

Similar statistics are reported from other countries as well and are summarized in Table 3. Spinks
and Moore (2007) report that across the Western world the average age of the working population
is increasing. In 2010, older workers (aged 55-64) will outnumber younger workers (aged 20-29)
for the first time. Canada leads the industrialised world in the speed at which the over 45 year old
labour force is increasing. Using simulation models for workforce planning, O’Brien-Pallas and

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colleagues (2005 p18) report “results indicate that if nurses retire by age 65, 13% of Canadian
nurses will be lost to retirement or death by the year 2006. However, if nurses retire by age 55,
Canada will lose almost 28% of the workforce by early 2006.”

Table 3: Age Profile

Country                      Average Age of                Retirement Age         Early
                             Employed Nurse                (By law)               Retirement Age
Canada                       44.7                          65                     55
Denmark                      43.8                          65                     60
Germany                      38.4                          65-67                  63
Iceland                      44                            70                     60
Ireland                      41.4                          65                     60
Japan                        37.9                          63
New Zealand                  44                            60                     55
Norway                       41                            65                     62
Sweden                       47                            65                     61
UK                           42                            65                     50
USA                          45.4                          65

(Data from the International Council of Nurses Nursing Workforce Profile, 2007)

Similar reports have emerged from Australia. More than 61 percent of nurses are 40 years of age
or older (O’Brien-Pallas et al. 2004 p298). As these nurses near retirement age it is projected to
exacerbate staffing difficulties in health care organisations. The Royal College of Nursing, Australia
(2004 p4) reports: “The proportion of workers aged over 45 increased by 17% between 1987 and
2001 and the under 35 decreased from 54% to 30% in the same time period.” The report goes
on to note that an ageing nursing workforce is not simply an Australian problem. “Figures for
England show that in 1996, 40% of National Health Service (NHS) nurses, midwives and health
visitors were under 35. By 1999 the proportion under 35 had dropped to 33% (and, in Scotland it
was 21% in 1998). At the same time the proportion over 45, that is, within ten years of retirement,
has increased from 27 to 29%.” In the United Kingdom all nurses and midwives who intend to
practice must be registered and in the space of just nine years there was a significant age-shift.
“The proportion in the youngest age groups halved, whilst those in the older age groups have
correspondingly increased” (Buchan 1999 p819). These nurses have retirement rights enabling
them to retire with full benefits at age 55.

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In The Bahamas, the picture is comparable. The median age of a public sector RN in 2005 is 40
years. The following statistics were provided by Marcel Johnson who is Acting Director of Nursing
in the Commonwealth of The Bahamas.

Table 4: Ages of nurses in The Bahamas

Age in Years           2000            2005
20-29                  18%             14%
30-39                  35%             28%
40-49                  30%             33%
50-59                  13%             17%
60+                    4%              8%

Of course, exceptions to this picture do occur. For example, in Malaysia, the average age of the
working nurse is 25 years. The age of the nurse population in a country profoundly impacts the
understanding of workforce dynamics and managerial implications. The picture is not the same in
developing and developed countries. For example, there are developing countries in the world
where the issue is not a shortage of nurses, but a shortage of funded nursing positions. In these
countries the ageing nurse population can be a very different issue. Elder or more senior nurses
are in positions desired by younger nurses. Thus, a bottleneck in career opportunities for younger
nurses is a very real issue. Prolonging the career of older nurses might not be the right strategy
where there are many waiting to become employed or promoted.

In countries where life span is increasing, the demands for health care services expand. Because
of the size of the generational cohorts, as ageing Baby Boomer nurses approach and reach
retirement, there are inadequate numbers of younger nurses to replace them; all at a time when
demand for health care services will reach an all-time high. It is no wonder that this rapidly
approaching collision of demographics has led to the identification of retaining the older nurse
as a key retention strategy for dealing with the nursing shortfalls being experienced. For countries
in this situation, this strategy is addressed in Section Four.

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Section Three:
Managing the Exit of Nurses from
the Workforce through Retirement
Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace (Hatcher
et al. 2006) reports that, of American nurses age 40 and over, more than 82 percent plan to retire
in the next 20 years. “One in five nurses in the UK is aged 50 years or older“ (Buchan 1999 p818).
Projections in other developed countries mirror this finding. It is little wonder that workforce
experts believe a viable strategy for easing this daunting potential nursing shortage is to retain
these nurses in the workforce for as long as possible. Canadian forecasters used simulation
models to project the probable result. O’Brien-Pallas and colleagues (2005) conclude that almost
half of the projected losses from nurses retiring could be avoided if the health care system
retained 100 percent of nurses aged 50-54, 75 percent of those aged 55-59, and 50 percent of
those aged 60-64.

From a review of the literature it is clear that employers, as well as governments, who are
concerned about the vitality and size of their future workforce, consider the retention of the older
worker as a strategic initiative that has the potential of helping them achieve their goals. The
testimony before governmental bodies, appointment of special committees, and commissioned
research have all focused on what might be done to successfully retain the older person in the
workforce (Armstrong-Stassen 2004; Commonwealth of Australia 2003; Hatcher et al. 2006;
Walker 2007). In testimony before the US Senate Special Committee on Aging, Walker (2007 p4)
summed up the issue based on American population statistics. “The aging of the baby boom
generation, increased life expectancy, and fertility rates at about the replacement level are expected
to significantly increase the elderly dependency ratio— the estimated number of people aged 65
and over in relation to the number of people aged 15-64.” This ratio was one person over 65 per
every eight people aged 15-64 in 1950. The ratio is projected to increase to one person aged 65
and over for every three people aged 15-64 by 2050. This results in an enormous impact on the
federal government programmes of Social Security and Medicare. There will be fewer younger
workers to support those drawing benefits.

There are other indirect ramifications for any national economy. Some of the most significant
include fewer available workers to produce the goods and services that drive the economy, as well
as less taxable income resulting in lower government revenue. With increasing life expectancy,
people who retire at earlier ages will spend more years in retirement and draw on these pension
benefits for a longer period of time. Extending the length of time older people remain active in
the workforce not only provides necessary labour for a country but also delays their drawing on
retirement funds. As they remain in the workforce, their income also remains taxable, thereby
continuing to bolster federal revenues.

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Factors Influencing Older Nurses’
Employment Decisions
A key issue rarely addressed is how amenable older nurses would be to employer strategies and
public policies designed to encourage them to remain on the job. In a Canadian study, Moriessette,
Schellenberg and Silver (2004) asked retired respondents what factors might have influenced
them to continue working. The participants were 1.8 million persons who retired between 1992 and
2002. Overall, 60 percent of recent retirees indicated a willingness to continue working if certain
incentives had existed. These incentives included: a reduction of work schedule without pension
being affected; more vacation leave; salary increased; and, availability of suitable caregiving
arrangements. One-third of the recent retirees left the workplace because of health reasons.
Another third would not have continued working for any of the reasons offered. The researchers
concluded that the remaining third of healthy retirees would have been willing to remain in the
workforce (at least partially) and this category of employees offer employers the best prospect for
increasing the overall supply of labour.

In reviewing these results, it must be noted that the retirees in this study are most likely members
of the Veterans’ generational cohort. It has been suggested in the literature (Lancaster & Stillman
2002) that retirement is perceived differently by members of the different generations. Veterans
tend to view retirement as reward while members of the Baby Boom generation see it as a time to
retool and try other things. This may explain the finding in the Canadian study that “compared
to their counterparts aged 60-64, retirees aged 50-59 were more likely to report that they would
have continued working” (Morissette et al. 2004 p3). If the Baby Boom generation, which is fast
approaching retirement age, sees retirement as a time to retool, they may actually be more
amenable to incentives that keep them in the workforce.

Watson, Manthorpe and Andrews (2003a and 2003b) conducted a study that investigated issues
related to options, decisions and outcomes for nurses aged over 50 in terms of remaining in, retiring
from, or returning to work in the National Health Services in the UK.

The following needs were identified:

• Flexibility: in the form of part-time work, job-sharing, flexitime, or school term-time working
  for older nurses with care responsibilities for children

• Fitness: this included working in areas with reduced stress and workload as well as changes
  of work practices and better use of equipment to reduce physical strain

• Stress: significant stressors were identified including staff shortages, excess paperwork, and
  insufficient time to complete tasks properly

• Pay

• Morale among nurses: related to nurses feeling valued for their contributions, involved in
  participating in decisions about their work, respecting the older nurse

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Watson and his colleagues conducted interviews of older nurses who were remaining in
the workplace, had retired from, or had returned to an employment setting. These are the
significant findings:

• Although many older nurses mentioned flexibility in conjunction with a supportive environment
  as influencing their own decisions about employment, examples of flexible working alternatives
  were not evident in the workplace.

• “There was a widespread feeling among the nurses interviewed, whether remaining or retired,
  that stress and the associated burnout were major influences on decision making with regard to
  employment over the age of 50” (Watson et al. 2003b p38).

• A major influence on older nurses’ employment decisions was money. Many of the nurses were
  the sole earner in their family, or were working to supplement the family’s income.

• Pension considerations often dictated whether it was appropriate for the nurse to retire at a
  particular time or whether it was worthwhile to work for a few more years to increase the
  pension. The need for changes in the National Health Services superannuation scheme could
  result in less penalty for older nurses accepting part-time work or reducing their hours and
  responsibilities in other ways.

• Almost all of the nurses in the study reported that little or no information was offered to them
  about their options. Just at a time when the nurse needs sound advice before making a decision,
  they are left on their own to find relevant information.

Armstrong-Stassen (2004) conducted research in Ontario, Canada, to evaluate human resource
management practices that are important in the decision of nurses aged 50 and older to remain
in the workforce. A second objective of the research was to determine the extent to which
healthcare facilities are engaging in these practices.

The five most important human resource management practices in retaining older nurses were:
1. Improving benefits
2. Showing appreciation for a job well done
3. Providing flexible work schedules
4. Recognizing the experience, knowledge, skill and expertise of nurses 50 and over
5. Ensuring that nurses 50 and over are treated with respect by others in the organization

The five least important human resource management practices in retaining nurses were:
1. Adjusting efforts to attract nurses 50 and over
2. Offering elder or parental care provisions such as unpaid leave
3. Offering job sharing
4. Providing “age awareness” training programmes for managers
5. Encouraging later, rather than early, retirement

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“The retention of nurses 50 and older will be strongly influenced by human resource management
practices” (Armstrong-Stassen 2004 p25); however, the findings of the study report several
significant shortfalls in how these organisations are actually doing.

These are the key findings from these nurse respondents:
• 72 percent ranked improved benefits as very important in their decision to remain in the
  workforce yet only 3 percent reported that their employer is highly engaged in doing this.

• 67 percent rated recognizing the experience, knowledge, skill and expertise of the older nurse
  as very important to their remaining actively employed. Only 12 percent of these nurses reported
  their hospital/agency as currently highly engaged in doing so.

• 67 percent rated flexible working options as very important and only 14 percent of the nurses
  reported that their hospital/agency is currently highly engaged in doing this.

• Providing educational support was rated as very important by 57 percent of the nurses and yet
  only 15 percent reported that their hospital/agency is currently highly involved in doing this.

• 62 percent indicated that redesigning work processes to minimize the negative impact on nurses’
  health was very important in their decision to remain actively employed, yet only 4 percent of
  these nurses indicated that this is occurring in their workplace. 83 percent of the nurses also
  reported that their employer is not currently engaged in reducing workload pressure and job
  demands of nurses 50 and over.

• 63 percent indicated that providing retirement with callback arrangements (reemployment of
  retirees on a part-time or temporary basis) is very important to their decision to remain in the
  workplace. Only 4 percent reported that their employer is actively involved in providing any type
  of phased retirement options.

The American Association of Retired Persons (AARP) conducted a survey in 2003 (reported in
Feinsod & Davenport 2006 p20) of more than 2,000 workers aged 50-70 to determine the specific
workplace attributes these workers are seeking.

Among those interested in working in their retirement years, the most important aspects include:
• An environment in which their opinions are valued and in which they can gain new skills
  and experiences

• The ability to choose their hours, take time off to care for relatives or loved ones and work
  from home

• An organisation that allows people aged 50 and older to remain employed for as long as they
  want to continue working

• Access to good health benefits

These are some of the only actual research studies reported. Although the literature review
revealed an extensive number of articles written suggesting strategies for retaining older nurses,
only a limited number were based on empirical evidence. In many cases, strategies are recommended
because they are thought to be helpful in retaining the older nurse in the workplace.

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Strategies for Retaining the Older Nurse
The strategies most commonly suggested can be categorized into the following six areas:
1. Correcting myths and misperceptions of and about older workers
2. Creation of a high quality, positive work environment
3. Changes in the physical environment
4. Alterations in the work itself (job redesign, new roles)
5. Restructured compensation and benefits
6. Flexible work schedules

Correcting myths and misperceptions of and about
older workers
In some countries there are strong incentives for persons of a certain age to retire. There exists a
culture of retirement which encourages workers to claim retirement benefits and stop working as
early as possible. In other countries there are limits to how long a worker may be actively employed
and/or mandatory retirement ages which are stringently enforced. This creates a perception in the
minds of citizens that after a certain age continued participation in the workforce is undesirable.

One of the most common misperceptions is that older workers cost an employer more. This is
based on the logic that the older worker has more tenure and is at a higher rate of compensation in
addition to having more health problems than younger workers. “One of the age-related employment
issues of particular concern in nursing is the high incidence of back injury amongst older nurses”
(Buchan 1999 p824). Watson and colleagues report that the percentage of back injuries is over
three times higher for nurses over aged 55 (2003a, 2003b). However, overall health status may not
be as significant an issue as believed. Norman (2005) found that although work setting varied with
the nurse’s age, there were no significant differences in self-reported health status by age. However,
Norman did report that many nurses fear developing neck and back injuries from direct patient
care, which may induce some nurses to leave the acute care environment.

Additionally there are many negative stereotypes about older workers including the belief that these
workers produce lower quality work than their younger counterparts and do less work overall. Buchan
(1999 p824) found that “Whilst there was general support for the desirability of employing older
nurses, most managers also expressed the opinion that nursing work was ‘changing’ in ways which
made it more challenging for older nurses.” This included more rapid patient throughput and higher
patient acuity in hospitals, and higher patient dependency in community nursing. Some employers
believe the older members of the workforce are more resistant to change. Organisations that adhere
to this conventional wisdom are missing a critical opportunity to maximize their talent base.

The US-based firm of Towers & Perrin studied this issue extensively for AARP and found that most
of these stereotypes are not grounded in fact. They found that motivation in workers tends to
increase with age (Feinsod & Davenport 2006). Older workers were more engaged and thus less
likely to leave, resulting in costly turnover. The findings related to productivity and age vary. Some
studies suggest that worker productivity tends to decline between the ages of 30 and 40 while
other studies found no significant differences. It was found that the increased knowledge and
experience of older workers can actually offset any cognitive declines that may occur with age.
This study also found that the cost impact of hiring and retaining older workers is quite modest, at
the most approximately 3 percent.

Under this strategy can be included the age bias as perceived by workers. Eliminating age bias is
much harder than might be expected (Wolf 2001). Despite age discrimination protection in developed
countries, there still exists the notion that “older people have had their day and should make

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room for the next generation” (Grossman 2003 p1). Grossman reports the results of an AARP
study that surveyed 1,500 employed workers age 45-74 which found that 67 percent said age
discrimination is a fact of life in the workplace and that they have concerns about opportunities to
advance. Sixty percent believed that older workers are the first to go when employers reduce their
staff. Another survey, he reports, finds 25 percent of workers planning to retire in the next five
years were leaving because they were being held back or felt marginalized because of their age.

Many older workers are reluctant to report their plans for retirement or phasing out of the workforce
because of their fear of being replaced. There is a history of older workers being replaced during
organisational restructurings or reductions in force. Older nurses may be hesitant to talk openly
about their plans for fear they may be replaced precipitously. Organisations and managers must
build a climate of trust where these issues can be discussed frankly. Only a partnership approach
makes it possible to do adequate workforce planning. For example, in the case of an older nurse
considering altering the work arrangement to meet personal commitments such as providing care
for a grandchild or simply because of desired lifestyle changes, if there is freedom to talk about
this openly with the manager, alternatives can sometimes be negotiated.

Suggestions for dealing with these misperceptions include the advice to:
• Confront these biases with facts
• Seek out older nurses and consider them for open positions
• Always hire the best person for the job regardless of age
• Offer job retraining and educational programmes to update skills or develop new skills
• Train managers on communication preferences and motivators for the different age groups

Creation of a high quality, positive work environment
Clearly a crucial aspect of a positive work environment is one where generational differences
are recognized, respected and tapped into as a source of strength. Good nurses are looking for
departments and organisations where people work well cross-generationally. To develop this kind
of open, trusting culture, many employers are implementing training and educational sessions for
all employees on the differences and uniqueness of the different groupings. Employers are also
seeking ways to accommodate the priorities of multiple generations and implementing work-life
balance strategies that are sensitive to multiple generations.

This is important in retaining older nurses. Once an individual is financially able to retire, if the
workplace is unpleasant or a source of conflict and strife, the environment becomes a push factor,
i.e. an element that exerts force and pressure on the individual to leave. Thus, one key strategy is to
do everything possible to create a work environment where employees enjoy working together, where
the connections between people are strong and healthy, and where the employees’ needs are being
met. Research conducted by McIntosh, Palumbo and Rambar (2002) found that the most important
determinant of job satisfaction among older nurses is working with helpful and friendly people.

A workplace where stress is manageable and the nurse is respected, valued and appreciated for
contributions is one that is more likely to retain the older nurse (Armstrong-Strassen 2004; Buchan
1999; Watson et al. 2003a, 2003b) “The most effective solution, experts say, is to become a good
place to work” (Thrall 2005 p32). This sounds simplistic, but in fact it is a key responsibility of any
nurse manager. And, the results benefit not just the older worker but workers from every age cohort.

Understanding the basic human motivators as discussed in Section One and referring to the
extensive literature on positive, healthy practice environments is a good place to begin.

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Changes in the physical environment
In a survey of 377 nurses (Hatcher et al. 2007), it was found that older nurses were more likely to
be employed in ambulatory settings or home care. Hospital work is physically challenging and,
without accommodations, many nurses leave or transfer to less demanding jobs. Some take early
retirement. “Nursing is complex and taxing physical, emotional and intellectual work. Over time
this takes a toll on the nurse” (Hatcher et al. 2007 p22).

Many strategies have been suggested that take into account the older worker’s physical needs.
There are certainly some age-related challenges that can impact productivity, such as a different
perception of light and sound, reduced physical endurance, reduced range-of-motion and muscle
strength, as well as longer reaction time. Many organisations are taking these age-related physical
changes into account. In some cases, institutions have employed ergonomic experts to follow
nurses during their daily work to determine unnecessary stressors.

Approaches identified in the literature include:
• New technology for lifting patients or reducing the need to lift patients (for example, stretcher
  beds that fold into a chair, or lift systems installed over the hospital bed)

• Implementing special lift teams

• Bariatric patient equipment or special accommodations

• Transport teams

• Back care and lift safety training

• Redesigning the work area to reduce the length of hallways and walk time with smaller more
  localised nursing stations and supply areas; patient assignments in clusters to avoid long
  distances and excessive walking. Nurses often walk up to 12 miles per shift, and much of this is
  related to finding supplies and equipment (Hatcher et al. 2007)

• Applying principles of ergonomics to the workplace such as ergonomically appropriate chairs,
  supplies placed at levels where they are easy to reach, electrical outlets placed at mid-height to
  prevent stooping

• Improved lighting, larger computer screens, lowered monitor screens, larger text type, and
  magnifiers (reading glasses) on all crash carts, with emergency equipment, in medication rooms

• Relaxation rooms, staff rest areas, chairs so people can sit, rolling chairs in the nursing station

• Door handles that lift rather than turn; easy-to-open containers

• Training materials that are easier to read (high contrast colours, bold type-facing, avoidance of
  high-gloss items and laminated pages that produce glare)

• No posting materials above eye level, which is hard to read with bifocals
• Reduction of noise levels

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Alterations in the work
Most of the approaches clustered under this strategy involved changing the job position or
classification in which the nurse worked. Approaches ranged from reducing typical responsibilities,
moving into different roles, to the creation of new roles within the health system.

In Australia, for example, the option is offered for the employee to transition into retirement by
working at a lower job classification level. While this may not suit everyone, it is one alternative
(Commonwealth of Australia 2003). In other countries this may happen in a less formal way, for
example, when nurse managers scale down their work commitment and phase out of certain
responsibilities toward the end of a career.

“From the Canadian perspective, the biggest challenge for many senior nurses is the issue of
workload. Senior nurses not only need to provide direct patient care and carry a full nurse patient
assignment, they also ‘manage the activities’ of the unit and serve as mentors or preceptors to
more junior nurses or relief staff” (O’Brien et al. 2004 p301). A reduction in this workload could
reduce the stress associated with balancing these three types of job demands.

In some countries, nurses reaching a certain age are automatically moved from bedside nursing
into positions in administration or education (Abdullah S. Al Mahrouqi, personal interview, 2007).
This is similar to the finding in the Robert Wood Johnson Foundation report Wisdom at Work that
many of the older nurses surveyed had transferred into ambulatory or home care nursing. Others
may seek positions in case management, quality improvement, or other related departments and
functions. Some nurses take on project work or roles that are time-limited, such as coordinator for
special projects.

Other systems are searching for entirely new roles that can tap into the knowledge and experience
of these mature workers. Examples include titles and positions such as Chief On-Boarding Officer
who assists newer nurses when they join the staff or Best Practice Coach who reviews the literature
and research for implementation of evidence-based nursing strategies. Using senior nurses to staff
community or wellness programmes or for tutoring high school students were other examples.
Other organisations use the older nurse in knowledge transfer programmes, aimed at mentoring
and developing newer staff to ensure the transfer of knowledge from the older, more experienced
nurse. In Guyana the government decided to recruit retired nurses to fill the shortages in their
HIV/AIDS Reduction and Prevention Projects (GHARP). This strategy prevents nurses employed
elsewhere in the system from being hired away from their current jobs. When this programme
began, GHARP received 495 applications for 61 available positions (WHO 2006).

In some countries mandatory retirement ages have forced exits from the workforce. For instance, in
Samoa, 99 percent of nurses and midwives are employed in the health service and are public servants.
They are eligible for retirement at 55 and required to retire at age 60. Because of the workforce
shortages experienced, these workers are now allowed to continue beyond 60 years of age as long
as they are certified medically fit and competent (personal communication, Pelenatete Stowers).

In some instances, it is suggested that moving the older nurse from the bedside results in the loss
of tremendous clinical expertise to the system. Flexible staffing patterns, compressed shifts, and
improved physical work environments can all help the more mature nurse handle the requirements
of traditional clinical nursing. Another option is to “shift roles so work is more appealing to older
nurses, perhaps alternating patient care with other duties” (Thrall 2005 p34). Norman (2005)
found, in the USA, that as the age of nurses increases, the percentage of nurses working in acute
care declines, from 72 percent of 18-29 year olds to only 38 percent of nurses 50 and over. In
Iceland, regulations allow nurses to work as long as they wish and their health allows. Most state

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employees in Iceland work until they are 70, which is encouraged by the design of the mandatory
contributory pension scheme. State institutions may employ nurses older than 70 but it is typically
with reduced pay, greater entitlement to sick pay, and mostly in nursing homes.

A key aspect of this strategy may involve retraining the individual for different responsibilities. In the
AARP study quoted earlier, this approach is one that is likely to be very appealing to older workers.

Restructured compensation and benefits
This strategy involved reviewing compensation plans and modifying traditional approaches to
provide creative, appealing, and individualised benefits. However, as noted by The Royal College of
Nursing, Australia (2004 p4) “When the average nurse retires at 55, the Government changes to
superannuation will make it easier for individuals to carry on working past 55, but improvements
in flexible working conditions will have to improve further.” In other words, it still has to be a good
place to work.

Compensation plans — Some employers looked for ways to rehire their own retirees. Often this
included modifying pension plans in ways that entice workers to remain in the active workforce.
Some organisations are offering employees the option of rehiring, working, and still being able to
claim their pension benefits. Other alternatives included allowing the individual to work for six
months but receive their pay over a year’s time. In the UK, the nurse’s pension is based on the
past five years of service. This discourages nurses from reducing to part-time work or accepting a
lower paying role in the final years of their career (Watson et al. 2003a, 2003b). In one area of the
UK there are provisions in place to protect the nurse’s earnings. “Nurses redeployed to a job with
lower pay than their previous position may have their earnings protected at the level of their
previous job for up to nine years, including the past five years of service on which their pension is
based. In this way staff need not be scared into early retirement to protect their pension” (p39).

Benefits — Benefits that were of special interest to the older nurse such as on-site or subsidized
health club memberships, subsidized health care insurance coverage, and rehabilitation time were
identified. “Considering that 38-87% of all nursing personnel have suffered a back injury severe
enough to require leave from work”, back-to-work programmes focusing on rehabilitative needs
are a sound benefit (Cyr 2005 p565).

Other benefits included educational opportunities that focus on the employee continuing to learn
new material and skills as well as tuition reimbursement for formal academic programmes. These
may be especially appealing to the generation of Baby Boomers. If they see their retirement as a
time to retool and pursue other interests, having assistance from their current employer to do so
could be very appealing. Financial literacy programmes were mentioned frequently. Because
people in developed countries are living longer, they will be increasingly responsible for preparing
for their own retirement.

Other examples were more perks or rewards rather than funded benefit programmes. Examples of
these include reduced floating and overtime for long tenured employees, retiree clubs, newsletters
and periodic social events. Concierge services are a group of perks that has enjoyed an upsurge of
interest in recent years, most likely in high-income countries. Organisations are implementing
these services because they can assume simple but time-consuming chores for employees making
their lives easier and allowing them to stay focused on their jobs. Although a few of these services
have been around for years (such as on-site dry cleaning services), Lima (2007) reports on a
startlingly wide and increasingly sophisticated array of these services.

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Examples include services such as:

Running errands — courier services, vehicle services, shopping, home-sitting

Convenience services — dry cleaning, shipping and mailing, gift wrapping

Transactional services — obtaining theatre tickets, buying gifts, making reservations

Home-based help — waiting for the arrival of a service person, handling lawn maintenance issues,
watering plants, bringing in the mail, arranging for pet care

Corporate support — conducting fund raising campaigns, administering recognition programmes

Information research — product research, travel, contractors, recreation, sports, financial services,
volunteering opportunities

Child or elder care — researching care options, identifying programmes and services

Event planning — planning an employee recognition dinner, a business meeting, the organisation’s
or department’s summer picnic, a birthday party, a reunion, or any other event

Travel planning — obtaining passports, arranging airfare/hotel/car rental, exchanging currency

Flexible work schedules
“Labor force decisions of older workers are also influenced by the availability of flexible work
arrangements” (Walker 2007 p9). There were many examples of this throughout the literature.
Older workers find it difficult to manage 12-hour shifts while younger workers find clustering these
longer shifts gives them a longer personal break and better work-life balance. Longer shifts are
physically more demanding and can be difficult for the older worker who may be experiencing less
endurance as age advances. There were any number of flexible work plans identified.

Phased-retirement plans — These are also called bridge options and usually include a transition
period from full-time work into part-time work prior to full retirement. For example, in Mauritius
following the nursing shortages in the years 2002-2005, an External Bank Nurse System was
introduced. Retired nurses were recruited into the bank system of four hours per session. These
nurses can do two sessions per day for a maximum of 20 sessions per month. They can also do less
and are paid per session. It is a flexible system that allows the nurse to offer services at a comfortable
pace. Pension payments are not affected by participation and the nurse is exempted from night
duty. Participation by retired nurses does not prevent others from aspiring to promotions.

Part-time work — This is not necessarily part of a formal phased-retirement plan, but allows the
worker more time for life-balance. One form of this is a weekender option that enables the
individual to work weekends only.

Job sharing — This is an arrangement where two or more people share a full-time job.

Seasonal work or temporary work — This refers to programmes that allow workers to only work
part of the year. In one US case, a nurse lives in Florida for six months out of the year and returns
to Cleveland, Ohio to work six months during the summer. Another option is the Traveller Option
which offers 6-13 week assignments.

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In Australia, a programme called flexible leave options, or purchased leave, can be made available
to employees (Commonwealth of Australia 2003). Employees can purchase between one and four
weeks of additional leave time per year. An adjustment is then made to the employee’s annual
salary to repay the additional leave. Another programme allows employees to work half of the
year and be paid over a full year.

In Jamaica nurses are civil servants and retire at 60 years of age unless they are University
employees who retire at 65. The nurses may be retained on a contractual basis for two years or
they can work as seasonal employees.

Caregiving time — This option is useful for those with elder care responsibilities. One employer
provides workers ten days off each year for elder care. In a study by Rosenfield (2007) interviews
were completed with 28 elder caregiving nursing staff. They reported that successful management
of their dual roles was based on identifying departments and shifts that fit with their responsibilities.
Caregiver-friendly practices such as creative, flexible scheduling; access to social workers,
financial and legal services; and increased awareness among managers about caregiver strains
were recommended.

Project work — This is work that is temporary but may be full-time while the project is unfolding.
Once the project is over, the job goes away.

Home-based work — This allows employees to work their regular or reduced hours from another
location. While most of nursing work takes place in the presence of patients, and thereby must be
on site, there are responsibilities that may lend themselves to this alternative. Administrative
paper work, reviewing research, developing programmes, and other project work are just a few
examples of possible work done as effectively from home. Home-based work is especially attractive
to older workers who have caring responsibilities for an ill spouse or elderly relative where the
care is ongoing but not time-consuming.

Another variation of this is the example of hospitals that are using the older nurse in assignment
at a centralized monitoring station for intensive care patients. In our highly connected, electronic
world, there will be increasing opportunities for long-distance assignments. This may also have
ramifications for countries that are providing outsourcing services for other countries, for example,
radiologists in India or Australia who provide interpretation of imaging results for hospitals in
the USA.

Career breaks — In Australia (Commonwealth of Australia 2003 p10) it was found that “career
break schemes may enable employees to pursue interests or activities outside of the workplace,
which may assist in the transition from full-time work to retirement—for example, leave to pursue
volunteer activities or other special interests.” These interruptions in service can also enable older
workers to attend to intensive or more long-term caring responsibilities. Some organisations
actually encourage employees to plan a sabbatical and make it possible for the employee to be
paid four years’ salary over a period of five years. The fifth year is spent out of the workplace.

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It is important to note that there is a range of personal and organisational circumstances and
preferences, and, as such, a one-size fits all approach is not likely to succeed. Approaches must be
customized for the country and workforce for which they are intended. Furthermore, there is only
limited research reported that demonstrates these strategies increase a nurse’s intent to remain in
the active workforce.

Spinks and Moore (2007) suggest that retirement ages are more unpredictable for women than
they are for men because we are only now beginning to experience large numbers of women in
the paid labour force working until retirement. Because the nursing workforce is largely women,
this caution should be noted. “Women, more often than men, report being pulled into retirement
involuntarily or prematurely as a result of spousal retirement, caregiving demands of an elderly
family member for personal health reasons” (Spinks and Moore 2007 p27). Further, they state that
although studies have shown that people plan to work into their 60s and 70s, the reality is that
very few people choose to work beyond the time at which their personal health/wealth equation
permits retirement.

Cyr (2005) conducted a descriptive survey of 1,553 hospital-based nurses in central New England,
USA. Most of this sample (65%) anticipated retiring after 60 years of age, with 31 percent indicating
they would retire at or before 60 years old. This finding differs from earlier reports that nearly
half of all men and women leave the labour force by ages 60 and 62 respectively, and that nurses
tend to retire earlier. Cyr ranked the factors influencing retirement decisions in terms of their
frequency of mention.

They are as follows:
Financial independence (75%)
Nurse’s poor health (63%)
Work intensity (48%)
Spouse’s poor health (39%)
Spouse’s early retirement (28%)

In examining these factors related to the strategies just reported, there are several that can be
influenced. Nurses who said financial independence would influence their early retirement also
indicated that financial incentives would encourage them to remain employed. Work intensity was
cited by 48 percent of the study participants as a reason for ending their professional careers
early. Many of the managerial interventions cited focus on easing the physical demands of the
workplace. Approximately half of the nurses indicated that some form of flexible work would be
desirable and have a positive effect on the retention of older staff members.

Much more research is needed to determine the relative importance and effectiveness of these
strategies. However, many of the findings and recommendations reported here are approaches
that make the organisation a better workplace and hold true for both younger and older nurses.
While this paper focuses on retaining the older nurse as a strategy inherent in managing a
multi-generational workforce, there is hope that these strategies can help alleviate the current
nursing shortage crisis. Making these workplace changes can make health care a better work
environment for all nurses and perhaps avert the worst of future workforce shortfalls.

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Section Four:
Policy Implications
While much can be accomplished at the organisational level, there are several policy
implications that emerge from this review of the literature. All of these recommendations must
be considered in light of the context and goals of the country in which they are applied (Buchan
& Calman 2005).

The following suggestions are offered:

1. Revisit laws requiring a mandatory age of retirement. In countries where life expectancy is
increasing, previously established ages for retirement may no longer be reasonable.

2. Evaluate policies and practices that are punitive for workers remaining in the active workforce.
For example, in Cameroon, there is strict implementation of retirement at 50 or 55, a limit of
employment to 30 years, suspension of any financial promotion and a reduction of additional
benefits after a certain age (Kingma 2007 p1286).

3. Consider modifications in tax laws to encourage people to continue working and collect their
pensions. “There is a need to encourage ongoing employment among older clinicians (albeit at
reduced hours)” such as concessional taxation (Schofield and Beard 2005). Revisit laws that are
punitive for individuals who desire to continue to work, such as those discontinuing payment of
pension benefits or Social Security benefits if compensation earned exceeds a certain level.

4. Address age discrimination. Governments worldwide must work to combat age discrimination
in the workplace and provide incentives for employers to hire older qualified workers. Evaluate
the age discrimination legislation which may have inadvertently discouraged employers from
hiring the more mature worker.

5. Work to change the mind-set about older workers. Walker (2007 p10) testified that a change
is needed “in the national mind-set about work at older ages and that a national campaign to
promote this concept was needed”. Educational programmes about the contributions of older
workers that help dispel the myths and misperceptions may be necessary.

6. Institute methodology for nursing workforce planning so there is comparable data that can be
used for making decisions. “Internationally, nursing workforce planning is a priority for policy
planners. Strategies to effectively plan for and manage nurses and other health care providers
are of utmost importance. In addition, adequately resourced policies to deal with the ongoing
issues of recruitment and retention need to be developed, implemented, and evaluated to determine
their utility.” (O’Brien-Pallas et al. 2005 p5)

7. Invest in creating and maintaining readily accessible databases to allow comparison of needs
across countries, to understand the needs within a country, and to determine whether policies
are working.

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8. Create an international clearinghouse to share best practices for recruitment and retention,
safe working conditions, flexible working models, career structure, and dissemination of research

9. Create models of retirement and retention scenarios to indicate the usefulness of policies
targeting older age cohorts and assist in monitoring and managing an ageing nursing workforce.

10. Consider possible policy initiatives that modify the work environments to retain older nurses.

11. Create programmes in the public sector to help displaced workers retrain or find new skills in
order to remain active in the workforce.

12. Consider having portable pensions (in countries where nurses work in the private sector)
to allow nurses to transfer existing pensions to other institutions without having to retire.

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Nurse managers in many countries are facing a significant challenge with the presence of multiple
generations of nurses in the active workforce. The challenges of managing a multi-generational
workforce are multiple including the need of the manager to: create a positive work environment;
remain flexible and adaptable; manage conflict between the generations; and, understand and use
knowledge of the generational differences. Not all generational characteristics and descriptors are
conclusive for every member of the generation, so it remains important that managers know the
people with whom they work and not generalize or stereotype based on these characteristics.
Furthermore, although there are obviously generational differences, there are also many similarities
between people and it may also be productive to focus on the basic human intrinsic motivators to
create a workplace that is positive and appealing to employees regardless of the generational
cohort to which they belong.

Nursing demographic information is sketchy in many countries and it is difficult to report on specific
profiles of nurse age. However, in most countries a potentially viable strategy for resolving nursing
workforce shortfalls is the retention of the older nurse. More research is needed in this area to
determine the factors that would effectively influence nurses to remain in the active workforce.
Strategies being reported include: correcting misperceptions about older workers; interventions
to make the employment setting a good place to work; changes in the physical environment and
alterations in the work to make both more conducive to the older worker; restructured compensation
and benefit packages; and flexible work schedules.

Many of these strategies can be carried out at the individual manager or organisational level.
However, there are also broad, policy implications for governments to consider. All strategies and
policy implications have the potential impact of creating a health care environment that is good
for nurses and better for those people the nurses serve.

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